This document discusses strategies for revamping India's National Rural Health Mission (NRHM). It provides background on NRHM, launched in 2005 to strengthen rural health infrastructure and address gaps in health services. The document outlines NRHM's goals of reducing infant and maternal mortality, increasing access to public health services, and integrating vertical health programs. It also discusses NRHM's strategies, functioning through local health committees and Accredited Social Health Activists, and issues with coordination between programs and lack of performance monitoring. The document concludes with recommendations to address lack of trained personnel and improve association of district health societies for better NRHM implementation.
The document summarizes India's health care delivery system. At the central level, the Ministry of Health and Family Welfare oversees various departments and organizations. These include the Central Council of Health, which advises on health policy, and the Director General of Health Services. States have their own health ministries and directorates. Primary health care is delivered through a network of sub-centers, primary health centers (one per 30,000 people in plains), and community health centers. The primary focus is on maternal and child health, immunization, and other basic services.
Health care delivery system in india- community medicinevini2016
The document outlines India's health care delivery system. It discusses the goals and principles of the system, which aims to provide comprehensive and affordable primary health care through community health workers and public facilities from the village level up to community health centers. The key aspects of the system include primary health centers staffed by multipurpose health workers that refer patients to secondary level community health centers. The National Rural Health Mission further aims to strengthen these primary care services.
The document discusses healthcare planning and management. It covers the following key points in 3 sentences:
Planning in healthcare involves defining health problems, identifying unmet needs, surveying resources, and establishing feasible goals and actions. It includes formulation, execution, and evaluation of plans. The National Rural Health Mission in India aimed to improve access to rural healthcare by strengthening primary healthcare centers and providing community health workers.
This document provides an overview of India's health care delivery system from the national to local levels. It describes the organization and functions of key bodies like the Ministry of Health and Family Welfare, Directorate General of Health Services, and Central Council of Health at the national level. It also outlines the structure of health services delivery at the state, district, community, primary health center, and sub-center levels. The national government is responsible for policy, planning, and coordination, while states each have their own independent health care systems.
The health system in India is organized across three levels - central, state, and district. At the central level, the key organizations are the Ministry of Health and Family Welfare, Directorate General of Health Services, and Central Council of Health and Family Welfare. The Ministry is responsible for health policy, programs, and departments related to health and family welfare. It aims to improve population health, care experience, and social justice. The Directorate General provides technical guidance and oversees health programs and facilities. The Central Council promotes coordination between central and state governments on health issues.
Health system in india at district levelKailash Nagar
The document discusses the organizational structure of healthcare delivery at the district level in India. The key points are:
1. The district health system is headed by the Chief Medical and Health Officer who oversees all health and family welfare programs. They are assisted by other program officers.
2. The district is divided into subdivisions, tehsils, community development blocks, municipalities, and villages. Healthcare services are provided at each level through various public health facilities.
3. In addition to the CMHO, other important officers include the District Tuberculosis Officer, District Malaria Officer, and District Leprosy Officer who are responsible for implementing specific disease control programs.
This document provides an overview of health status, health problems, and healthcare delivery in India in 3 paragraphs:
The first paragraph summarizes India's overall health status, including high private healthcare expenditures mostly out-of-pocket, lower public expenditures per capita, and leading health issues like communicable diseases, nutritional problems, and environmental sanitation issues.
The second paragraph outlines India's major public healthcare system, which operates primary care centers and hospitals at state and central levels but has unequal access between rural and urban areas. It also describes limited public health insurance programs.
The third paragraph discusses the large private healthcare sector concentrated in urban areas, as well as indigenous medicine systems and voluntary organizations that provide additional healthcare access across
The document summarizes India's health care delivery system. At the central level, the Ministry of Health and Family Welfare oversees various departments and organizations. These include the Central Council of Health, which advises on health policy, and the Director General of Health Services. States have their own health ministries and directorates. Primary health care is delivered through a network of sub-centers, primary health centers (one per 30,000 people in plains), and community health centers. The primary focus is on maternal and child health, immunization, and other basic services.
Health care delivery system in india- community medicinevini2016
The document outlines India's health care delivery system. It discusses the goals and principles of the system, which aims to provide comprehensive and affordable primary health care through community health workers and public facilities from the village level up to community health centers. The key aspects of the system include primary health centers staffed by multipurpose health workers that refer patients to secondary level community health centers. The National Rural Health Mission further aims to strengthen these primary care services.
The document discusses healthcare planning and management. It covers the following key points in 3 sentences:
Planning in healthcare involves defining health problems, identifying unmet needs, surveying resources, and establishing feasible goals and actions. It includes formulation, execution, and evaluation of plans. The National Rural Health Mission in India aimed to improve access to rural healthcare by strengthening primary healthcare centers and providing community health workers.
This document provides an overview of India's health care delivery system from the national to local levels. It describes the organization and functions of key bodies like the Ministry of Health and Family Welfare, Directorate General of Health Services, and Central Council of Health at the national level. It also outlines the structure of health services delivery at the state, district, community, primary health center, and sub-center levels. The national government is responsible for policy, planning, and coordination, while states each have their own independent health care systems.
The health system in India is organized across three levels - central, state, and district. At the central level, the key organizations are the Ministry of Health and Family Welfare, Directorate General of Health Services, and Central Council of Health and Family Welfare. The Ministry is responsible for health policy, programs, and departments related to health and family welfare. It aims to improve population health, care experience, and social justice. The Directorate General provides technical guidance and oversees health programs and facilities. The Central Council promotes coordination between central and state governments on health issues.
Health system in india at district levelKailash Nagar
The document discusses the organizational structure of healthcare delivery at the district level in India. The key points are:
1. The district health system is headed by the Chief Medical and Health Officer who oversees all health and family welfare programs. They are assisted by other program officers.
2. The district is divided into subdivisions, tehsils, community development blocks, municipalities, and villages. Healthcare services are provided at each level through various public health facilities.
3. In addition to the CMHO, other important officers include the District Tuberculosis Officer, District Malaria Officer, and District Leprosy Officer who are responsible for implementing specific disease control programs.
This document provides an overview of health status, health problems, and healthcare delivery in India in 3 paragraphs:
The first paragraph summarizes India's overall health status, including high private healthcare expenditures mostly out-of-pocket, lower public expenditures per capita, and leading health issues like communicable diseases, nutritional problems, and environmental sanitation issues.
The second paragraph outlines India's major public healthcare system, which operates primary care centers and hospitals at state and central levels but has unequal access between rural and urban areas. It also describes limited public health insurance programs.
The third paragraph discusses the large private healthcare sector concentrated in urban areas, as well as indigenous medicine systems and voluntary organizations that provide additional healthcare access across
The document summarizes India's health care delivery system. It has 3 main levels - central, state, and local. At the central level, the main organizations are the Ministry of Health and Family Welfare and the Directorate General of Health Services, which are responsible for policy, planning, research, and coordinating with states. At the state level, each state has its own health administration led by a health secretary. At the local level, districts are divided into subdivisions, blocks, and villages/panchayats. Primary health services are provided at the village, sub-center, primary health center, and community health center levels.
This document outlines Kerala's state health policy from 2013. It discusses 6 components of the health system and provides statistics on Kerala's demographics and health infrastructure. It describes the current scenarios around social determinants of health, emerging diseases, non-communicable diseases, and vulnerable populations. The plan of action focuses on improving determinants of health like water, sanitation, and poverty reduction. It also details reorganizing the public health system from primary to tertiary levels and strengthening specialized services like communicable disease control and mental health.
The document discusses India's health care delivery system at different levels from central, state, district, block and village. It provides definitions of health, health care services and health care delivery system. It describes the organization and functions of health care delivery at central level including various departments and bodies. It also discusses the organization at state level including state health ministry and directorate. The health care delivery system faces challenges in providing basic care to all citizens due to fiscal constraints.
Health care system in india at central levelKailash Nagar
The health care system in India consists of organizations at the central, state, and local levels. At the central level, the key organizations are the Ministry of Health and Family Welfare, the Directorate General of Health Services, and the Central Council of Health and Family Welfare. The Ministry has three departments and is responsible for policymaking, planning, and coordinating nationwide health programs. It is supported by the Directorate General of Health Services, which provides technical guidance. States have their own health systems and are responsible for implementation, while districts and local levels provide services. Healthcare spending in India was about 5% of GDP in 2013 and is growing rapidly driven by increases in public and private expenditures.
Health Status Of Uttar Pradesh and field visitAnita Gupta
The document provides information on the organization and management of health services in Uttar Pradesh at the state, district, and sub-district levels. It summarizes that at the state level, the Principal Secretary oversees health policy and budgets, while various Directors provide technical assistance. At the district level, the CMO manages programs, and the SMO oversees individual health centers. The document also outlines the responsibilities and norms of community health centers, primary health centers, and sub-centers in the state.
This document provides guidelines for Indian Public Health Standards (IPHS) for district hospitals with 101 to 500 beds. It outlines the objectives, services, physical infrastructure requirements, manpower, equipment, and other essential components that a district hospital should provide and strive towards. Key points include:
- District hospitals should provide comprehensive secondary healthcare, be prepared for emergencies, and offer skill-based training.
- Services are categorized as essential (minimum) or desirable, and include specialty care, newborn care, and services for safety, infection control, and communicable diseases.
- Infrastructure, manpower, and equipment are projected based on expected patient load. Quality assurance, waste management, and safety protocols are incorporated
The document provides an overview of the healthcare system in India. It discusses the various sectors that make up the healthcare system including public, private, voluntary, and indigenous. It also outlines the different levels of healthcare facilities from primary to tertiary care. Additionally, it examines the role of various government agencies at the central, state, and local levels in managing public health programs and regulating the healthcare industry.
The current five year plan in Nepal's health services aims to increase rural access to basic primary health services and doctors. It focuses on effective implementation of population control through mother and child health and family planning services. The plan also seeks to develop specialized health services within the country. Key targets include establishing more health posts, primary health care centers, and Ayurvedic dispensaries. It also aims to reduce the total fertility rate and cases of leprosy.
The document provides an overview of India's health care delivery system from the central, state, district, and local levels. At the central level, the key organizations are the Union Ministry of Health and Family Welfare and the Directorate General of Health Services, which are responsible for policymaking, planning, and coordinating health services nationwide. States each have their own health administration systems led by state health ministries and directorates. Districts are the main administrative units and have chief medical officers overseeing integrated preventive and curative services. Local health services are delivered through primary health centers, community development blocks, municipalities, and panchayats (village councils).
Unit 2 - Central health services management part 1 & 2 pdfDipesh Tikhatri
The document discusses the roles and responsibilities of various health organizations in Nepal, including the Ministry of Health and Population, Department of Health Services, regional health directorates, and provincial health directorates under the new federal system. The key responsibilities include formulating health policies, planning and implementing health programs, managing health facilities and resources, coordinating stakeholders, and expanding access to quality health services.
Human Resource crisis in rural health care in Indiadeepakdass69
The document summarizes the evolution of rural healthcare in India from the Bhore Committee in 1943 to the present. It outlines the structural hierarchy from sub-centers to primary health centers to community health centers. It identifies key challenges including a severe shortage of rural health workers, issues with their development, deployment, and management, and problems with education and training. A case study using the Warr Job Satisfaction scale found low levels of satisfaction among rural health workers.
Health planning in India is an integral part of national socio-economic planning (2, 13). The guide-lines for national health planning were provided by a number of Committees dating back to the Bhore Committee in 1946.
This presentation deals with Primary Health Care in India. It describes in detail concept & characteristics of PHC. It focuses on structure, service delivery & challanges in front of Primary Health Care in India.
The document discusses the organization and functions of nursing services in hospitals and communities. It describes how hospital nursing services are organized with roles like the chief nursing officer, nursing superintendent, ward sister and staff nurses. It also outlines the functions of community health nursing which focuses on protecting and improving the health of entire geographical communities. Nursing services in both settings aim to provide preventive care, health education and rehabilitation in addition to curative services.
The document outlines several principles of community health nursing:
1) Community health nursing is community focused and requires understanding the defined community and establishing relationships.
2) Services should be based on identified community health needs and integrated within total community health programs.
3) Health services should be available and accessible to all without discrimination.
4) Community health nurses are accountable to health authorities and should function as part of a team within the policies and goals set by health agencies.
This document provides an overview of primary health care in India. It discusses the historical evolution of health care approaches from Bhore Committee to Alma-Ata Declaration. The key principles of primary health care are equitable distribution, community participation, intersectoral coordination, appropriate technology, focus on prevention. The primary health care system in India operates at village, sub-centre and primary health centre levels. It aims to provide basic health services to rural populations through community health workers like ASHA and anganwadi workers.
This document provides an overview of the health care delivery system in India. It describes the organizational structure at the central, state, district, block, primary health center, and village levels. The key shortcomings are discussed as inverse care, impoverishing care, fragmented care, unsafe care, and misdirected care. Reforms proposed by the WHO are also outlined, including universal coverage, service delivery, public policy, and leadership reforms. The objectives and importance of establishing Indian Public Health Standards are also presented. In conclusion, it acknowledges advances but notes the system remains ineffective and discusses needed reforms and decentralization to improve healthcare quality and delivery.
This is just a short & simplified slide made easy for undergraduate level . Important things have been highlighted. Before classifying system,I felt that few terms have to be described, so I have put few extra slides in the beginning.
A time series analysis of the determinants of savings in namibiaAlexander Decker
This document summarizes a study on the determinants of savings in Namibia from 1991 to 2012. It reviews previous literature on savings determinants in developing countries. The study uses time series analysis including unit root tests, cointegration, and error correction models to analyze the relationship between savings and variables like income, inflation, population growth, deposit rates, and financial deepening in Namibia. The results found inflation and income have a positive impact on savings, while population growth negatively impacts savings. Deposit rates and financial deepening were found to have no significant impact. The study reinforces previous work and emphasizes the importance of improving income levels to achieve higher savings rates in Namibia.
A transformational generative approach towards understanding al-istifhamAlexander Decker
This document discusses a transformational-generative approach to understanding Al-Istifham, which refers to interrogative sentences in Arabic. It begins with an introduction to the origin and development of Arabic grammar. The paper then explains the theoretical framework of transformational-generative grammar that is used. Basic linguistic concepts and terms related to Arabic grammar are defined. The document analyzes how interrogative sentences in Arabic can be derived and transformed via tools from transformational-generative grammar, categorizing Al-Istifham into linguistic and literary questions.
The document summarizes India's health care delivery system. It has 3 main levels - central, state, and local. At the central level, the main organizations are the Ministry of Health and Family Welfare and the Directorate General of Health Services, which are responsible for policy, planning, research, and coordinating with states. At the state level, each state has its own health administration led by a health secretary. At the local level, districts are divided into subdivisions, blocks, and villages/panchayats. Primary health services are provided at the village, sub-center, primary health center, and community health center levels.
This document outlines Kerala's state health policy from 2013. It discusses 6 components of the health system and provides statistics on Kerala's demographics and health infrastructure. It describes the current scenarios around social determinants of health, emerging diseases, non-communicable diseases, and vulnerable populations. The plan of action focuses on improving determinants of health like water, sanitation, and poverty reduction. It also details reorganizing the public health system from primary to tertiary levels and strengthening specialized services like communicable disease control and mental health.
The document discusses India's health care delivery system at different levels from central, state, district, block and village. It provides definitions of health, health care services and health care delivery system. It describes the organization and functions of health care delivery at central level including various departments and bodies. It also discusses the organization at state level including state health ministry and directorate. The health care delivery system faces challenges in providing basic care to all citizens due to fiscal constraints.
Health care system in india at central levelKailash Nagar
The health care system in India consists of organizations at the central, state, and local levels. At the central level, the key organizations are the Ministry of Health and Family Welfare, the Directorate General of Health Services, and the Central Council of Health and Family Welfare. The Ministry has three departments and is responsible for policymaking, planning, and coordinating nationwide health programs. It is supported by the Directorate General of Health Services, which provides technical guidance. States have their own health systems and are responsible for implementation, while districts and local levels provide services. Healthcare spending in India was about 5% of GDP in 2013 and is growing rapidly driven by increases in public and private expenditures.
Health Status Of Uttar Pradesh and field visitAnita Gupta
The document provides information on the organization and management of health services in Uttar Pradesh at the state, district, and sub-district levels. It summarizes that at the state level, the Principal Secretary oversees health policy and budgets, while various Directors provide technical assistance. At the district level, the CMO manages programs, and the SMO oversees individual health centers. The document also outlines the responsibilities and norms of community health centers, primary health centers, and sub-centers in the state.
This document provides guidelines for Indian Public Health Standards (IPHS) for district hospitals with 101 to 500 beds. It outlines the objectives, services, physical infrastructure requirements, manpower, equipment, and other essential components that a district hospital should provide and strive towards. Key points include:
- District hospitals should provide comprehensive secondary healthcare, be prepared for emergencies, and offer skill-based training.
- Services are categorized as essential (minimum) or desirable, and include specialty care, newborn care, and services for safety, infection control, and communicable diseases.
- Infrastructure, manpower, and equipment are projected based on expected patient load. Quality assurance, waste management, and safety protocols are incorporated
The document provides an overview of the healthcare system in India. It discusses the various sectors that make up the healthcare system including public, private, voluntary, and indigenous. It also outlines the different levels of healthcare facilities from primary to tertiary care. Additionally, it examines the role of various government agencies at the central, state, and local levels in managing public health programs and regulating the healthcare industry.
The current five year plan in Nepal's health services aims to increase rural access to basic primary health services and doctors. It focuses on effective implementation of population control through mother and child health and family planning services. The plan also seeks to develop specialized health services within the country. Key targets include establishing more health posts, primary health care centers, and Ayurvedic dispensaries. It also aims to reduce the total fertility rate and cases of leprosy.
The document provides an overview of India's health care delivery system from the central, state, district, and local levels. At the central level, the key organizations are the Union Ministry of Health and Family Welfare and the Directorate General of Health Services, which are responsible for policymaking, planning, and coordinating health services nationwide. States each have their own health administration systems led by state health ministries and directorates. Districts are the main administrative units and have chief medical officers overseeing integrated preventive and curative services. Local health services are delivered through primary health centers, community development blocks, municipalities, and panchayats (village councils).
Unit 2 - Central health services management part 1 & 2 pdfDipesh Tikhatri
The document discusses the roles and responsibilities of various health organizations in Nepal, including the Ministry of Health and Population, Department of Health Services, regional health directorates, and provincial health directorates under the new federal system. The key responsibilities include formulating health policies, planning and implementing health programs, managing health facilities and resources, coordinating stakeholders, and expanding access to quality health services.
Human Resource crisis in rural health care in Indiadeepakdass69
The document summarizes the evolution of rural healthcare in India from the Bhore Committee in 1943 to the present. It outlines the structural hierarchy from sub-centers to primary health centers to community health centers. It identifies key challenges including a severe shortage of rural health workers, issues with their development, deployment, and management, and problems with education and training. A case study using the Warr Job Satisfaction scale found low levels of satisfaction among rural health workers.
Health planning in India is an integral part of national socio-economic planning (2, 13). The guide-lines for national health planning were provided by a number of Committees dating back to the Bhore Committee in 1946.
This presentation deals with Primary Health Care in India. It describes in detail concept & characteristics of PHC. It focuses on structure, service delivery & challanges in front of Primary Health Care in India.
The document discusses the organization and functions of nursing services in hospitals and communities. It describes how hospital nursing services are organized with roles like the chief nursing officer, nursing superintendent, ward sister and staff nurses. It also outlines the functions of community health nursing which focuses on protecting and improving the health of entire geographical communities. Nursing services in both settings aim to provide preventive care, health education and rehabilitation in addition to curative services.
The document outlines several principles of community health nursing:
1) Community health nursing is community focused and requires understanding the defined community and establishing relationships.
2) Services should be based on identified community health needs and integrated within total community health programs.
3) Health services should be available and accessible to all without discrimination.
4) Community health nurses are accountable to health authorities and should function as part of a team within the policies and goals set by health agencies.
This document provides an overview of primary health care in India. It discusses the historical evolution of health care approaches from Bhore Committee to Alma-Ata Declaration. The key principles of primary health care are equitable distribution, community participation, intersectoral coordination, appropriate technology, focus on prevention. The primary health care system in India operates at village, sub-centre and primary health centre levels. It aims to provide basic health services to rural populations through community health workers like ASHA and anganwadi workers.
This document provides an overview of the health care delivery system in India. It describes the organizational structure at the central, state, district, block, primary health center, and village levels. The key shortcomings are discussed as inverse care, impoverishing care, fragmented care, unsafe care, and misdirected care. Reforms proposed by the WHO are also outlined, including universal coverage, service delivery, public policy, and leadership reforms. The objectives and importance of establishing Indian Public Health Standards are also presented. In conclusion, it acknowledges advances but notes the system remains ineffective and discusses needed reforms and decentralization to improve healthcare quality and delivery.
This is just a short & simplified slide made easy for undergraduate level . Important things have been highlighted. Before classifying system,I felt that few terms have to be described, so I have put few extra slides in the beginning.
A time series analysis of the determinants of savings in namibiaAlexander Decker
This document summarizes a study on the determinants of savings in Namibia from 1991 to 2012. It reviews previous literature on savings determinants in developing countries. The study uses time series analysis including unit root tests, cointegration, and error correction models to analyze the relationship between savings and variables like income, inflation, population growth, deposit rates, and financial deepening in Namibia. The results found inflation and income have a positive impact on savings, while population growth negatively impacts savings. Deposit rates and financial deepening were found to have no significant impact. The study reinforces previous work and emphasizes the importance of improving income levels to achieve higher savings rates in Namibia.
A transformational generative approach towards understanding al-istifhamAlexander Decker
This document discusses a transformational-generative approach to understanding Al-Istifham, which refers to interrogative sentences in Arabic. It begins with an introduction to the origin and development of Arabic grammar. The paper then explains the theoretical framework of transformational-generative grammar that is used. Basic linguistic concepts and terms related to Arabic grammar are defined. The document analyzes how interrogative sentences in Arabic can be derived and transformed via tools from transformational-generative grammar, categorizing Al-Istifham into linguistic and literary questions.
A trends of salmonella and antibiotic resistanceAlexander Decker
This document provides a review of trends in Salmonella and antibiotic resistance. It begins with an introduction to Salmonella as a facultative anaerobe that causes nontyphoidal salmonellosis. The emergence of antimicrobial-resistant Salmonella is then discussed. The document proceeds to cover the historical perspective and classification of Salmonella, definitions of antimicrobials and antibiotic resistance, and mechanisms of antibiotic resistance in Salmonella including modification or destruction of antimicrobial agents, efflux pumps, modification of antibiotic targets, and decreased membrane permeability. Specific resistance mechanisms are discussed for several classes of antimicrobials.
A unique common fixed point theorems in generalized dAlexander Decker
This document presents definitions and properties related to generalized D*-metric spaces and establishes some common fixed point theorems for contractive type mappings in these spaces. It begins by introducing D*-metric spaces and generalized D*-metric spaces, defines concepts like convergence and Cauchy sequences. It presents lemmas showing the uniqueness of limits in these spaces and the equivalence of different definitions of convergence. The goal of the paper is then stated as obtaining a unique common fixed point theorem for generalized D*-metric spaces.
A universal model for managing the marketing executives in nigerian banksAlexander Decker
This document discusses a study that aimed to synthesize motivation theories into a universal model for managing marketing executives in Nigerian banks. The study was guided by Maslow and McGregor's theories. A sample of 303 marketing executives was used. The results showed that managers will be most effective at motivating marketing executives if they consider individual needs and create challenging but attainable goals. The emerged model suggests managers should provide job satisfaction by tailoring assignments to abilities and monitoring performance with feedback. This addresses confusion faced by Nigerian bank managers in determining effective motivation strategies.
A usability evaluation framework for b2 c e commerce websitesAlexander Decker
This document presents a framework for evaluating the usability of B2C e-commerce websites. It involves user testing methods like usability testing and interviews to identify usability problems in areas like navigation, design, purchasing processes, and customer service. The framework specifies goals for the evaluation, determines which website aspects to evaluate, and identifies target users. It then describes collecting data through user testing and analyzing the results to identify usability problems and suggest improvements.
Abnormalities of hormones and inflammatory cytokines in women affected with p...Alexander Decker
Women with polycystic ovary syndrome (PCOS) have elevated levels of hormones like luteinizing hormone and testosterone, as well as higher levels of insulin and insulin resistance compared to healthy women. They also have increased levels of inflammatory markers like C-reactive protein, interleukin-6, and leptin. This study found these abnormalities in the hormones and inflammatory cytokines of women with PCOS ages 23-40, indicating that hormone imbalances associated with insulin resistance and elevated inflammatory markers may worsen infertility in women with PCOS.
The document discusses various national health programs in India, including the National Health Mission, Reproductive and Child Health programs, the Revised National Tuberculosis Control Program, and others. It provides details on the goals, strategies, and initiatives of programs like NRHM, RCH, and NUHM. The document also discusses achievements of the National Rural Health Mission since its launch in 2005.
Health and family welfare (eleventh five year plan)Sa Rah
The document discusses India's 11th five year health plan. Key points include:
- Promoting access to healthcare through community health workers and developing village-level health plans.
- Integrating vertical health programs and providing technical support to state and district health missions.
- Goals of reducing maternal mortality, infant mortality, malnutrition, and improving sex ratios.
- Thrust areas include expanding access to AYUSH, increasing health resources, improving equity, and decentralizing governance.
This document summarizes the key objectives of health programs in India's five-year plans from the first plan in 1951 to the tenth plan in 2002-2007. The main objectives across most plans were to strengthen basic health services, control communicable diseases, develop health infrastructure and resources, promote family planning and population control, and improve maternal and child health services. Public sector spending on health programs increased with each successive plan.
The document summarizes key aspects of India's 2012-2013 health budget. It allocates increased funding to programs like the National Rural Health Mission and introduces new initiatives like the National Urban Health Mission. Specific funding increases are provided for rural sanitation and vaccination programs. The budget also aims to strengthen existing healthcare infrastructure through programs like the Pradhan Mantri Swasthya Suraksha Yojana.
Primary health care is the basic level of health care that aims to provide universal access to affordable services. It is defined by the World Health Organization as essential care made accessible to all at an affordable cost. In India, primary health care is delivered through a network of subcenters, primary health centers, and community health centers. It focuses on health education, nutrition, water/sanitation, maternal/child health, disease prevention/control, and treatment of common illnesses and injuries. Challenges include inadequate infrastructure, staffing and resources. Strategies to strengthen primary health care in India include community involvement, capacity building, recruiting qualified personnel, and modifying education programs.
The document summarizes key aspects of India's 2012-2013 health budget. It allocates more funding to programs like the National Rural Health Mission and ASHA workers. The budget also launches the National Urban Health Mission to address health challenges in cities. It increases funding for rural sanitation and vaccination programs while allowing tax deductions for preventative health spending. Overall, the health sector budget saw a 14% increase but some argue the allocation remains inadequate.
The document presents information on India's National Health Policies from 1983 to 2017. It discusses the goals and strategies of policies from 1983, 2002, and 2017. The key goals of policies included access to primary care for all, reducing mortality and disease prevalence, and achieving universal health coverage. The policies aimed to improve health infrastructure, personnel training, and integrate different medical systems to make progress toward health for all.
The document outlines the National Rural Health Mission in India from 2005-2012. The mission aimed to improve healthcare access for rural populations by increasing public health spending, reducing regional disparities, and decentralizing healthcare administration. Key strategies included appointing a female community health worker in each village, preparing village-level health plans, strengthening primary healthcare centers, integrating vertical health programs, and promoting affordable access through public-private partnerships and health insurance. The goals were to reduce infant and maternal mortality and ensure universal access to primary healthcare services.
India is the second rank in population and developing in the world. It leads to other countries by own Scio-economic, cultural way. Any country health affects growth in their average expectancy and various socioeconomic indicators like Human Development Index, Multidimensional Poverty Index, and Gross Domestic Product per capita other way reducing the burden of disease. Children, pregnant and lactating women are the most affected with a reduction in cognitive and physical growth and prone to unhealthy which directly affect the productivity of the country. After independence in Indian constitute have a provision in part -IV (Article -45, 47) development of nutritional strategies and intervention in the five-year plans. Hence Government has devised several nutrition programmes like National Nutritional Anaemia Prophylaxis Programme, National Goitre Control Programme, National, Iodine Deficiency Disorders Control Programme, Midday Meal Programme, Applied nutrition Programme, Akshaya Patra Program. The activities in each program have been seen and its impact assessed by various evaluation programs and it was found that these programmes helped the nation. They helped to provide the proper nutrition to the children and women. The implementation of these principles, together with intensification of public health and primary care services, offers an approach to ensure more equitable health care for India’s population. Keywords: India, nutritional programs, Article-45, 47
The document summarizes the evolution of universal health coverage in India from 1946 to present. Key milestones include recommendations from committees such as the Bhore Committee in 1946 which recommended integrating preventive and curative services and establishing primary health centers. Other committees addressed issues like medical education reform, strengthening district hospitals, and establishing a unified health cadre. National policies in 1983, 2002, and 2017 aimed to provide comprehensive primary health care through a decentralized public health system. Key programs launched include the National Rural Health Mission in 2005, National Health Mission in 2013, and Ayushman Bharat in 2018 which aims to provide health insurance coverage to 500 million Indians.
The document provides information about a Certificate Course in Community Health (CCCH) being offered by the DINSHA PATEL College of Nursing, NADIAD. The 6-month course will train mid-level providers to operationalize Health and Wellness Centers under the Ayushman Bharat program. It describes the 5 modules that will be covered including basics of community health, primary health care for common conditions, clinical skills, national health programs, and public health management. The course aims to equip community health workers with the skills needed to provide comprehensive primary healthcare in rural areas.
The document provides information about a Certificate Course in Community Health (CCCH) being offered by the DINSHA PATEL College of Nursing, NADIAD. The 6-month course will train mid-level providers to operationalize Health and Wellness Centers under the Ayushman Bharat program. It describes the 5 modules that will be covered including basics of community health, primary health care for common conditions, clinical skills, national health programs, and public health management. The course aims to equip community health workers with the skills needed to provide comprehensive primary healthcare in rural areas.
The document summarizes India's national health policies from 1983 to the present. The National Health Policy of 1983 emphasized primary healthcare and established a decentralized system. It was revised in 2002 to optimize healthcare access and include social policies. The current 2017 policy focuses on priority areas like cleanliness, nutrition, and disease control. It outlines various health programs targeting issues like maternal/child health, communicable/non-communicable diseases, and health system strengthening. The policies aim to provide comprehensive and equitable healthcare coverage across India.
This document discusses India's health care delivery system. It begins by outlining the challenges in reaching the whole population with adequate care and describes how large hospitals failed to meet community needs. It then examines how health status, problems, and available resources are assessed to determine priorities. Key health issues in India include communicable diseases, nutrition, sanitation, medical access, and population growth. The primary health care system aims to make services accessible, affordable, and participatory. It operates on village, sub-centre, and primary health centre levels to deliver basic care.
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Strategies for revamping of national rural health mission in india
1. Developing Country Studies www.iiste.org
ISSN 2224-607X (Paper) ISSN 2225-0565 (Online)
Vol 2, No.2, 2012
Strategies for Revamping of National Rural Health Mission in
India
Brij Pal*
* Department of Public Administration, S. A. Jain College, Ambala City 134003, Haryana, India
E-mail of the corresponding author: drbrijpal@yahoo.com
Abstract
Recognizing the significance of health, Government of India launched National Rural Health Mission
(NRHM) in 2005. A lot of emphasis was given to strengthen the rural health infrastructure, including the
physical manpower, and other facilities. However, as on date a huge gap is clearly visible between demand
and supply of health centers, and facilities. The current health conditions are one of the reasons for India’s
poor rank in Human Development Index. This programme has put rural public health care firmly on the
agenda, and is on the right track with the institutional changes it has wrought within the health system. This
paper is an attempt to highlight the development of health services in India. Besides, the goal and strategies of
NRHM has been discussed in detail. Present paper also explains the working of this programme which is a
programme to fulfill the objectives of Millennium Development Goal.
Keywords: NRHM, Health, Rural, PRIs
1. Introduction
Over the last several years in India there has been a drastic change in the national government’s approach to
the health sector. India was one of the pioneers in health service planning with a focus on primary health care.
It is estimated that, China in 2000 had a life- expectancy at birth of 69 years (M) and 73(F) whereas India had
respectively 60 (M) and 63 (F). More importantly, healthy life expectancy at birth in China was estimated in
the World Health Report 2001 at 61 (M) and 63.3 (F) whereas in Indian figures were 53 (M) and 51.7 (F). If
we look at the percentage of life expectancy years lost as a result of the disease burden and effectiveness of
health care systems, Chinese men would have lost 11.6 years against Indian men losing 12.7 years. The
corresponding figures are 13.2 for Chinese women and 17.5 for Indian women. Clearly, an integrated
approach is necessary to deal with avoidable mortality and morbidity and preventive steps in public health are
needed to bridge the gaps, especially in regard to the Indian women. Taking all the factors into consideration,
longevity estimates around 20-25 could be around 70 years, perhaps, without any distinction between men
and women. In 1946, the Health Survey and Development Committee, headed by Sir Joseph Bhose
recommended establishment of a well structured and comprehensive health service with a sound primary
health care infrastructure. In 1952, the Bhore Committees recommended to establish Primary Health Care
Centres to promote, prevent, curate and rehabilitate the services to entire rural population, as an integral
component of wider Community Development Programme. The convulsive political changes that took place
in the 1970s impelled the Central Government to implement the vision of Sokhey Committee of having one
Community Health Worker for every 1000 people to entrust ‘people health on people's hand'. India has come
quite close to Alma Ata Declaration on Primary Health Care made by all countries of the world in 1978. The
Declaration included commitment of governments to consider health as fundamental right; giving primacy to
expressed health needs of people; community health reliance and community involvement; Intersectoral
action in health; integration of health services; coverage of entire population; choice of appropriate
technology; effective use of traditional system of medicine; and use of only essential drugs. National Health
Policy was formed in 1982 to make architectural corrections in health care system. National Health Policy
gave a general exposition of the policies which require recommendation in the circumstances then prevailing
in health sector. The Universal Immunization Programme (UIP) was launched in 1985 to provide universal
coverage of infants and pregnant women with immunization against identified vaccine preventable diseases.
In 1997, Reproductive and Child Health (RCH- Phase1) programme was launched which incorporated child
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2. Developing Country Studies www.iiste.org
ISSN 2224-607X (Paper) ISSN 2225-0565 (Online)
Vol 2, No.2, 2012
health, maternal health, family planning, treatment and control of reproductive tract infections and adolescent
health. RCH Phase-2 (2005-2010) aims at sector wide, outcome oriented programme based approach with
emphasis on decentralization, monitoring and supervision which brings about a comprehensive integration of
family planning into safe motherhood and child health.
2. NRHM Model
Most of the Indian population lives in rural areas and they are suffering from long-standing healthcare
problems. It is estimated that only one trained healthcare provider including a doctor with any degree is
available per sixteen villages. Although more than 70 per cent of its population lives in the village, only 20
per cent of India’s hospital beds are located in rural areas. Most of the health problems that people suffer from
in the rural community and in urban slums are preventable and easily treatable. In view of the above issues,
the National Rural Health Mission (NRHM) was launched by the Government of India in April 2005. The
duration of NHRM will be from 2005 to 2012. The total allocation for the Departments of Health and Family
Welfare has been hiked from Rs 8420 crore to Rs 10,820 crore in the budget proposals for the year
2005–2006. NRHM is a flagship scheme of central government to improve the provision of basic healthcare
facilities in rural India by undertaking an architectural correction in the existing healthcare delivery system
and by promoting good health through improvements in nutrition, sanitation, hygiene and safe drinking
water. It also seeks to revitalize Indian health traditions of Ayurveda, Yoga, Unani, Siddha and Homeopathy
(AYUSH), and mainstream them in to the healthcare system. NRHM is an umbrella programme subsuming
existing health and family welfare programmes, such as the second phase of the Reproductive and Child
Health programme (RCH II), National Disease Control Programmes for Malaria, TB, Kala Azar, Filaria,
Blindness, Iodine Deficiency (NDCP), and the Integrated Disease Surveillance Programme (IDSP). By
integrating these vertical health programmes, This programme seeks to optimise utilisation of funds and
infrastructure, thereby strengthening delivery of public healthcare. A task force has been constituted to
recommend strategies for expanding the programme to include the urban poor
3. Objectives of NRHM
National Rural Health Mission seeks to provide effective healthcare to the rural population throughout the
country with special focus on eighteen states, which have weak public health indicators and weak
infrastructure. These states are Arunachal Pradesh, Assam, Bihar, Chhattisgarh, Himachal Pradesh,
Jharkhand, Jammu and Kashmir, Manipur, Mizoram, Meghalaya, Madhya Pradesh, Nagaland, Orissa,
Rajasthan, Sikkim, Tripura, Uttaranchal, and Uttar Pradesh. In the beginning Government of India was to
provide funding for key components in these eighteen high focus states. This programme has to cover all the
villages in these eighteen states through approximately 2.5 lakh village-based ‘Accredited Social Health
Activists’ (ASHA) who has to act as a link between the health centres and the villagers. One ASHA will be
raised from every village, or cluster of villages, across these eighteen states. The ASHA will be trained to
advise village populations about sanitation, hygiene, contraception, and immunization to provide primary
medical care for diarrhoea, minor injuries, and fevers; and to escort patients to medical centers. They would
also be expected to deliver direct observed short course therapy for tuberculosis and oral dehydration, to give
folic acid tablets and chloroquine to patients, and to alert authorities of unusual outbreaks of disease.
The goals of the NRHM were as given below:
• Reduction in Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR);
• Universal access to integrated comprehensive public health services;
• Child health, Water, Sanitation and Hygiene;
• Prevention and control of communicable and non-communicable diseases, including
locally endemic diseases;
• Population stabilization, gender, and demographic balance;
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3. Developing Country Studies www.iiste.org
ISSN 2224-607X (Paper) ISSN 2225-0565 (Online)
Vol 2, No.2, 2012
• Revitalization of local health traditions and main-stream Ayurvedic, Yoga, Unani, Siddha, and
Homeopathy Systems of Health (AYUSH);
• Promotion of healthy lifestyles;
• The strategies to achieve the goals include;
• Train and enhance capacity of Panchayati Raj Institutions (PRIs) to own, control and manage public
health services;
• Health plan for each village through Village Health Committee of the Panchayat;
• Strengthening sub-centre through an untied fund of Rs.10000 for local action and planning. This
Fund will be deposited in a joint Bank Account of the ANM and Sarpanch and operated by the
ANM, in consultation with the Village Health Committee, and more Multi Purpose Workers
(MPWs);
• Provision of 24 hour service in 50 per cent PHCs by addressing shortage of doctors, especially in
high focus states, through mainstreaming AYUSH manpower;
• Preparation and implementation of an intersectoral District Health Plan prepared by the District
Health Mission, including drinking water, sanitation, and hygiene and nutrition;
• Integrating vertical Health and Family Welfare programs at National, State, Block, & District levels.
The strategies to achieve the goals include:
• Train and enhance capacity of Panchayati Raj Institutions (PRIs) to own, control and manage public
health services;
• Health plan for each village through Village Health Committee of the Panchayat;
• Strengthening sub-centre through an untied fund of Rs.10000 for local action and planning. This
Fund will be deposited in a joint Bank Account of the ANM and Sarpanch and operated by the
ANM, in consultation with the Village Health Committee, and more Multi Purpose Workers
(MPWs);
• Provision of 24 hour service in 50 per cent PHCs by addressing shortage of doctors, especially in
high focus states, through mainstreaming AYUSH manpower;
• Preparation and implementation of an intersectoral District Health Plan prepared by the District
Health Mission, including drinking water, sanitation, and hygiene and nutrition;
• Integrating vertical Health and Family Welfare programs at National, State, Block, & District levels.
4. Functioning of NRHM in India
Health is listed as a state subject in the Indian Constitution while family welfare is in the concurrent list.
Primary healthcare is a subject of local self governments. Therefore, public expenditure is restricted by
resources available at the state and sub-state levels. NRHM envisages a significant role for communities in
the delivery and monitoring of primary healthcare. One of the scheme’s core strategies is to build the capacity
of Panchayati Raj Institutions (PRIs) to control and manage public health services. NRHM has a provision for
professional bodies and non-governmental organizations (NGOs) to conduct monitoring and evaluation. It
also relies on communities to monitor the delivery system and the provision of health services. Preparation of
annual district health report involves government line departments and NGOs, and state and national reports
are tabled in State Legislative Assemblies and the Parliament. At the national level, NRHM is a joint Mission
Steering Group, headed by the Union Minister of Health and Family Welfare, and an Empowered Programme
Committee, headed by the Union Secretary for Health and Family Welfare. A Mission Directorate has been
created for planning, implementation and monitoring day-to-day administration. At the state level, the State
Health Mission headed by the Chief Minister, carries out the activities through State Health Societies. At the
sub-state level, The District Health Mission shall be led by the Chairman of the Zilla Parishad, and be
convened by the District Head of the Health Department. It shall have representation from all relevant
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4. Developing Country Studies www.iiste.org
ISSN 2224-607X (Paper) ISSN 2225-0565 (Online)
Vol 2, No.2, 2012
Departments, NGOs and private professionals. District Health Societies are responsible for preparing
perspective plans for the entire period (2005-12), annual plans of all NRHM components and for integrating
public health plans with those for water, sanitation, hygiene and nutrition. Block level health plans on the
basis of district plans are formulated to integrate the village plans. Rogi Kalyan Samitis (RKS) at the block
level are responsible for the day-to-day management of hospitals. In each village, a Village Health and
Sanitation Samiti is accountable to the panchayat and is comprised of a female Accredited Social Health
Activist (ASHA) who is the bridge for the village, an ANM, a teacher, a panchayat representative, and
community health volunteers. Primary Health Centres are staffed by a medical officer and fourteen
paramedical staff, and provide integrated curative and preventive care. PHCs are the first point of contact
with a medical officer. At the block level, CHCs, serving as referral units for four PHCs, are manned by four
medical specialists (surgeon, physician, gynaecologist and paediatrician) and provide obstetric care and
specialist consultations. NRHM seeks to bring CHCs and PHCs on par with Indian Public Health Standards
(IPHS) and makes the provision of adequate funds and powers to enable these committees to reach desired
levels.
5. Issues
Poor coordination and integration with other health institutions is a major problem of NRHM. The
objectives of NRHM to increase expenditure on public health, provide access to healthcare to the rural poor.
It recognizes that diseases are caused by several factors and stresses on the convergence of inter-sectoral
services, such as nutrition, water, sanitation and hygiene. It integrates previously vertical disease-specific
programmes at the national, state and district levels, ensuring that these different aspects are represented in
the district health plan. NRHM is designed to coordinate efforts between related schemes such as Total
Sanitation Campaign, Integrated Child Development Services, Mid Day Meal, and National Disease Control
Programmes for Malaria, TB, Kala Azar, Filaria, Blindness & Iodine Deficiency and Integrated Disease
Surveillance Programme. However, Coordination between different ministries and integration between
various intersect oral programmes remains the biggest challenge for NRHM. The NRHM framework states
targets for public health outcomes, but lacks mechanisms to judge state performance against targets. Ministry
of Health & Family Welfare maintains annual state-wise data, but without state targets in the framework, it is
not possible to arrive at meaningful regional and inter-state comparisons. Baseline surveys, that are important
to estimate current status and to measure all future progress, were completed in only eight states and Union
Territories (UTs), were incomplete in eight, and were not initiated in twenty states and UTs. The lack of
baseline data prevents any meaningful evaluation of progress of the scheme in the states and in the country. In
the absence of complete, timely and accessible household and facility data it is not possible to adequately
plan future interventions based on relative need analysis.
6. Strategies for Implementation
6.1 Untrained Personnel
Lack of trained personnel and infrastructure is a major concern for proper implementation of NRHM.
Presently, at the District Level and below there is a hurry to achieve 'targets' which cannot be achieved in
absence of trained personnel and improvement in infrastructure. There is acute shortage of all categories of
staff in health sectors across the length and breadth of the nation. Most glaring are the lack of specialist
doctors, laboratory technicians, and male health workers. A need for a second Auxiliary Nurse Midwife
(ANM) is felt in all the states. According to the Bulletin of Rural Health Service on 31 December, 2008,
14851 SHCs had no ANM, 130812 had one ANM, and 25743 had two ANMs. At CHCs, 5117 specialists
were posted against a requirement of 16180. The gap was highest in the high focus North Eastern states where
only nine positions were filled against a demand of 868.To improve the health care system in rural areas , the
Government should ensure the proper arrangements of trained health personnel. There should be fixed quota
of the specialist doctors in the recruitment policy and some extra benefits should be given to these specialist.
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6.2 Association of District Health societies
Implementation of NRHM in many states like Jharkhand is very challenging .These states lacks the basic
infrastructures for implementation of national health programmes and state health societies were not
constituted here for long. Formation of District Health Societies in the districts was also delayed. It is
suggested that District Health Societies in each District should be constituted and the members of the these
societies should be aware about their rights.
6.3 Contribution of local self-government
At present, the NRHM is being seen as a package of schemes but in reality it is a participative programme of
different stakeholders like Community, PRIs, government and non-governmental organizations in a well
co-ordinated manner. The involvement of local self-governing bodies therefore seems very limited. NRHM
programme can be successful only with the involvement of PRIs. This programme could not achieve the
desired results due to petty politics at grassroot level and lack of political will. In tribal villages there are
Traditional Manki/Munda/Pahan and village heads without legal or administrative powers of the PRI system.
However, PRI participation has not been systematically implemented. There is no clear plan of Action,
including capacity building plans on how panchayats should be involved. The PRIs should be given some
legal and administrative powers for their active participation in the implementation of this programme. There
is need of capacity building of health service providers.
6.4 Dishonesty in Implementation
There is possibility of corruption in the implementation of this programme. Recent example of Uttar Pradesh
state indicates the possibility of corruption at higher level. The chief secretary of utter Pradesh conceded that
it was the rampant corruption at various levels in the execution of Rs.3,000 crores under NRHM schemes
that led to the murder of two successive chief medical officers in Lucknow. There should be check on the
corrupt practices of the engaged bureaucrats. The officials should engage civil societies and local peoples
while making expenditure on health services under NRHM.
6.5 Use of secure funds
Civil society engagement has not yet taken place at the state level . Unfortunately, sometimes united funds are
not being released at proper time and most of the Medical Officers and ANMs were unaware about the proper
utilization of these untied funds. Secondly, due to lack of proper training of Panchayati Raj Institutions, there
is lack of clarity on how the fund will be operated. There should be special steps taken to institutionalize civil
society participation in NRHM activities, including monitoring at the state and district levels. MNGOs
should be selected in consultation with civil society at the state level. The involvement of MNGOs as
principal NGO partners in planning and particularly monitoring processes should be reviewed as it can lead
to conflict of interests.
6.6 Patient Welfare Committees
There is provision of up gradation of PHCs and CHCs in the states. But in some states these PHCs CHCs have
not been upgraded. The quality Assurance Committee has not yet been constituted to maintain the medical
services. PRIs,ANMs &AWWs are also not aware about their duties and responsibilities. Thus the status of
NRHM is quite dismal in some states. It is suggested that proper training programmes should be organized
for the representatives of PRIs and they should be aware about the NRHM policies . The ANMs and AWWs
should be trained and held responsible for the quality assurance of medical services.
6.7 Public-private joint venture
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Public-private partnership processes should not encourage the privatization of health services. Financing
should be from public funds so that universal access to services is ensured. Other challenges hampering
access to better health services are, hard to reach areas, low acceptance level in some areas, extremist prone
areas, quality assurance in strengthening the Village Health Committee and Sahiya training, lack of
infra-structure and trained human resources and frequent transfer of health personnel. Mechanisms for
introducing social audits and Jan Sunwai should be drawn up and implemented with care as soon as possible.
District level planning has started in several places without village level planning processes being put in place
first. This may set a counterproductive precedent. Village level planning should be introduced as soon as
possible.
6.8 Appointment of Specialist
NRHM should welcome partnerships with the Non-Governmental Sector in a fully transparent manner to
ensure that quality services are available at affordable costs to communities. The Hospital Development
Committees at District, Sub-District, CHC, PHC, Hospitals is an opportunity to move towards need based
and health facility based engagement of Specialist services. In emergency there should be provision of
engagement of some specialist doctors working in the private hospitals under this programme.
7. Conclusion
The overall health status of the deprived and communally excluded population is meager in some states. The
reasons for the poor health status of millions of people are not hard to find. Major factor hindering access to
quality health services are lack of or non existing inter-sectoral linkages between different stakes holders.
This phenomenon is also found between different Government Departments. Here the role of Panchayati Raj
Institutions and civil society organizations becomes pertinent as one of the important stakeholder. There is
also need of forging alliances with wider determinants of health. Existence of services in terms of structure
will never ensure its utilization to fullest unless and until there is proper channel between different
stake-holders which can link people to these services. It requires concerted public action to establish an
accountable and affordable public health system, in partnership with non-governmental providers. It requires
participation of democratic institutions like Panchayats, user groups, women's groups, NGOs in health
delivery from public and non-governmental providers. Such health sector reforms require higher order of
management of resources. Even though much of the responsibility for efficient working of the public health
system lies upon the government, the people also need to assert their rights. To address the issues related to
quality primary health care services, capacity building of health service providers, accountability and use of
right to information for improving the quality of health care services are very critical factors. It is a challenge
to the PRI and civil society institutions to make a difference in improving the access to primary health care
services and contribute in ensuring access and utilization of services in their area. The factors that hinder
proper implementation of NRHM from the beginning are not addressing existing problems in the health
systems before initiating NRHM. Other reasons are lack of systematic coordination and implementation of
various programmes and mechanisms by state Governments.
References
Department for International Development (2008). Directory of Innovations Implemented in the Health
Sector, National Rural Health Mission, Ministry of Health and Family Welfare, Govt. of India. New Delhi:
Nirman Bhavan; Empowered Action Group. http://www.mohfw.nic.in/EAG.pdf
Ganeshan, G. (2001), “Health problems in Rural India”, Journal of Rural Development 46, 289-299.
Gill, Kaveri A. (2009), “Primary Evaluation of Service Delivery under NRHM: Findings from a study in
Andhra Pradesh, Uttar Pradesh, Bihar and Rajasthan”, Working Paper PEO, Planning Commission of India
3(2) 39-44.
Kaushik, P. K. (2010), “Primary Health Centres in Rural Areas”, Purva Mimansaa 2(2), 10-14.
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Vol 2, No.2, 2012
Swaminathan, S. (2008), “NRHM in Jharkhand”, Jharkhand Journal of Development and Management
Studies 6(3), 2987-2996.
Dr. Brij Pal (RO’02-APS’04-AP’08). The author became Research Officer (RO) in 2002 at the Institute of
Integrated Himalayan Studies (Center of Excellence under University Grants Commission) Himachal
Pradesh University, Shimla, India; Additional Private Secretary to Union Minister of Law & Justice,
Government of India in 2004 and Assistant Professor & Head Department of Public Administration in 2008
at S. A. Jain College, Ambala City, Haryana, India. The author obtained his Post Graduate and Doctor of
Philosophy Degrees in Public Administration and was awarded University Research Fellowship from
Kurukshetra University, Kurukshetra, Haryana , India. Besieds, he got LLB (Bachelor of Law) Degree from
Chaudhary Charan Singh University, Meerut, Uttar Pradesh, India. The major fields of studies are Rural
Development, Indian Administration and Contemporary Social Problems.
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